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General NPI Number Information
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NPI Number | 1407467434
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Entity Type | Organization
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Legal Business Name | LIFE CHANGES COUNSELING AND CONSULTANT SERVICES, LLC
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 1003 VIRGINIA AVE STE 104
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City | ATLANTA
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State | GA
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Zip | 30354-1366
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Country | US
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Telephone | 404-500-1994
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 VIRGINIA AVE STE 104
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City | ATLANTA
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State | GA
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Zip | 30354-1366
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Country | US
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Telephone | 404-500-1994
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TERENCE WILKINS
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Credential | LPC, MAC
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Telephone | 609-743-1773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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